LOL Ministry Request Form

    If you or someone you know at Rimrock Church has a need that we can help with, please let us know by filling out the form below. There are times we are not able to fulfill each request, (and we will let  you know) but our goal is to be of service!

    All requests and services are considered confidential, unless we are informed specifically that it is OK to share with others.

    The person making the request- please fill out this area:
    Name:
    Address: *
    Address Line 1
    Address Line 2
    City
    State/Prov.
    Postal Code
    Phone Number:*
    Email*
    If you are making this request for someone else, please list their contact information here:
    Name of person needing assistance (if not you)
    Address
    Address Line 1
    Address Line 2
    City
    State/Prov.
    Postal Code
    Phone Number:
    Email
    What is the nature of the situation?
    When is help needed? (i.e. urgent, next week, after surgery, etc)
    Other information that might be helpful in fulfilling the need: